Alpha-adrenergic blocking drugs in the management of benign prostatic hyperplasia: Interactions with antihypertensive therapy

Management of benign prostatic hyperplasia (BPH) is often complicated by concomitant hypertension, a life-threatening condition that must be managed optimally. Many of the α blockers used to treat BPH also decrease blood pressure, and terazosin and doxazosin have been shown to have significant cardiovascular side effects, such as asthenia/fatigue, postural hypotension, and dizziness when used to treat BPH patients. Furthermore, these drugs are not first-line therapies for hypertension, and the majority of hypertensive BPH patients will be receiving other antihypertensive agents. Therefore, it is possible that the introduction of these drugs will affect the blood pressure control, at least temporarily, with possible adverse effects. In contrast, the selective α(1A) blocker tamsulosin does not appear to have significant cardiovascular side effects and produces minimal blood pressure reductions. Therefore, urologists can choose either to use α blockers to treat both hypertension and BPH or to treat BPH using α blockers that do not interact with antihypertensive therapy. This review focuses on the α blockers currently being used to treat BPH, their effects on the cardiovascular system, and their interaction with antihypertensive drugs.